This invention relates to an immunosuppressant agonists and finds application in the field of health care. More particularly, this invention relates to a pharmaceutical composition for improving the action of an immunosuppressant which comprises insulin-like growth factor I (IGF-I) or its analog as an active ingredient and to the use thereof. Furthermore,.the invention relates to enhancement of IGF-I production with a macrolide compound.
The inventors of this invention found after intensive research that insulin-like growth factor I (IGF-I) inclusive of its analog has a strong effect for improving an action of immunosuppressants and that the immunosuppressive macrolide compound has a potent IGF-I production enhancing action, and have accordingly developed this invention.
IGF-I or its analog for use in this invention includes native IGF-I""s , products resulting from the fractional purification thereof, and IGF-I""s produced by recombinant DNA (c f. EP-A-155655, for instance), peptide synthesis, cell culture or other technology, for example those derived from the human, bovine or other mammal. The analog of IGF-I includes various IGF-I-active muteins available upon partial change, i.e. insertion, substitution, deletion and/or addition, in the amino acid sequence of IGF-I and chemical modification products such as O-glucosylated IGF-I (WO 90/02198). As a preferred example of such analog of IGF-I, there can be mentioned the muteins resulting from the deletion or omission of 1xcx9c5 amino acids from the N-terminus of the sequence as disclosed in WO 89/05822. To avoid undesirable immune responses, the use of IGF-I of the human origin or an analog thereof is preferred.
The xe2x80x9caction of an immunosuppressantxe2x80x9d in the context of this invention means the action that is expressed when a substance generally called immunosuppressant is administered to animals inclusive of man, specifically the immunosuppressive action, prophylactic/therapeutic action on diseases of the liver as described in U.S. Pat. No. 5,196,437, and/or liver anagenesis accelerating action.
More particularly, the xe2x80x9caction of an immunosuppressantxe2x80x9d includes the therapeutic or prophylactic action on the following conditions or diseases.
(1) The rejection of transplanted organs or tissues such as heart, kidney, liver, bone marrow, skin, etc.
(2) The graft-versus-host reaction in a bone marrow transplantation.
(3) Autoimmune diseases such as rheumatoid arthritis, systemic lupus erythematosus, Hashimoto""s thyroiditis, multiple sclerosis, myasthenia gravis, insulin-dependent diabetes mellitus, uveitis, etc.
(4) Postoperative complications in partial hepatectomy.
(5) Acute hepatonecrosis caused by toxins, viral hepatitis, shock or anoxia, or of unknown origin.
(6) Immunogenic diseases of the liver, e.g. chronic autoimmune diseases of the liver such as autoimmune hepatitis, primary biliary cirrhosis, sclerosing cholangitis, etc.
(7) Chronic diseases of the liver other than autoimmune hepatitis, such as virus B hepatitis, non-A, non-B hepatitis, cirrhosis (e.g. alcoholic cirrhosis, cirrhosis of unknown origin, etc.) and so on.
As a corollary, the preferred xe2x80x9caction improving the action of an immunosuppressantxe2x80x9d is the improvement and/or enhancement of the therapy or prophylaxis in the above-mentioned conditions or diseases.
The preferred other xe2x80x9caction of an immunosuppressantxe2x80x9d to be improved is the side effect of any substance known as an immunosuppressant and the xe2x80x9cimprovement of its actionxe2x80x9d is the alleviation or inhibition of the side effect. By way of illustration, immunosuppressants classed as xe2x80x9ccyclosporinsxe2x80x9d, particularly cyclosporin A (CsA), are known to cause various adverse reactions such as bone loss, suppression of choleresis, suppression of bile acid secretion, and cholestatic symptoms, and the immunosuppressant agonists of this invention alleviates or inhibits such side effects.
The xe2x80x9ccomposition for improving an action of immunosuppressantxe2x80x9d of this invention can be administered, either together with an immunosuppressant at one and the same time or independently at a different time, by an administration route judiciously selected from among the conventional routes (intravenous, intramuscular, subcutaneous, intraperitoneal, rectal, nasal, etc.). The amount of the active ingredient IGF-I or IGF-I analog in the composition for improving an action of the immunosuppressant need only be just enough to bring about the expected effect and is dependent on the patient""s age and the route of administration, among other conditions. Usually, however, the daily dose-of about 1xcx9c100 mg/kg, preferably about 1xcx9c20 mg/kg, as IGF-I, on an adult basis, can be administered in a single dose or in divided doses.
Regarding the dosage form of said xe2x80x9ccomposition for improving an action of an immunosuppressantxe2x80x9d, a suitable dosage form can be selected with reference to the route of administration to be used, from among various solid forms such as tablets, capsules, powders, granules, fine granules, troches, pills and suppositories, various semisolid forms such as ointments and creams, liquid forms such as solutions, suspensions, syrups and elixirs, and liposomes. Such pharmaceutical preparations can be manufactured by the routine procedures optionally employing a pharmaceutical carrier, excipient, stabilizer and other pharmaceutically acceptable additives. For use as an injection, the composition can be provided in the form of a solid preparation (e.g. lyophilized product) for extemporaneous reconstitution. Among such pharmaceutical preparations, there can be reckoned the freeze-dried preparation described in EP-A-440989 and the nasal. preparation described in JP Kokai H5-58877.
When the composition for improving an action of an immunosuppressant of this invention is to be administered together with an immunosuppressant at the same time, the IGF-I or IGF-I analog and the immunosuppressant may be formulated together, optionally with the aid of a pharmaceutical carrier, excipient, stabilizer and/or other pharmaceutically acceptable additives, in the routine manner and the resulting composition be put to use.
The immunosuppressant whose action is to be improved by this invention and the immunosuppressant to be used for the production of said composition comprising an IGF-I or its analog and an immunosuppressant may each be any substance having immunosuppressive activity.
Macrolide compound such as FK506, ascomycin derivatives, rapamycin derivatives, and so on; cyclosporins; and so on can be exemplified as the preferable examples.
More particular examples of the macrolide compounds, the tricyclic compound of the following formula (I) or pharmaceutically acceptable salts thereof can be exemplified. 
(wherein each of adjacent pairs of R1 and R2, R3 and R4, and R5 and R6 independently
(a) is two adjacent hydrogen atoms, but R2 may also be an alkyl group or
(b) may form another bond formed between the carbon atoms to which they are attached;
R7 is a hydrogen atom, a hydroxy group, a protected hydroxy group, or an alkoxy group, or an oxo group together with R1;
R8 and R9 are independently a hydrogen atom or a hydroxy group;
R10 is a hydrogen atom, an alkyl group, an alkyl group substituted by one or more hydroxy groups, an alkenyl group, an alkenyl group substituted by one or more hydroxy groups, or an alkyl group substituted by an oxo group;
X is an oxo group, (a hydrogen atom and a hydroxy group) (a hydrogen atom and a hydrogen atom), or a group represented by the formula xe2x80x94CH2Oxe2x80x94;
Y is an oxo group, (a hydrogen atom and a hydroxy group) (a hydrogen atom and a hydrogen atom), or a group represented by the formula Nxe2x80x94NR11R12 or Nxe2x80x94OR13;
R11 and R11 are independently a hydrogen atom, an alkyl group, an aryl group or a tosyl group;
R13, R14, R15, R16, R17, R18, R19, R22 and R23 are independently a hydrogen atom or an alkyl group;
R24 is an optionally substituted ring system which may contain one or more heteroatoms;
n is an integer of 1 or 2; and
in addition to the above definitions, Y, R10 and R23, together with the carbon atoms to which they are attached, may represent a saturated or unsaturated 5- or 6-membered nitrogen, sulfur and/or oxygen containing heterocyclic ring optionally substituted by one or more groups selected from the group consisting of an alkyl, a hydroxy, an alkoxy, a benzyl, a group of the formula xe2x80x94CH2Se(C6H5), and an alkyl substituted by one or more hydroxy groups.
Preferable R24 may be cyclo(C5-7)alkyl group which may have suitable substituents, and the following ones can be exemplified.
(a) a 3,4-di-oxo-cyclohexyl group;
(b) a 3-R20-4-R21-cyclohexyl group,
in which R20 is hydroxy, an alkoxy group, or a xe2x80x94OCH2OCH2CH2OCH3 group, and
R21 is hydroxy, xe2x80x94OCN, an alkoxy group, a heteroaryloxy which may be substituted by suitable substituent(s), a
xe2x80x94OCH2OCH2CH2OCH3 group, a protected hydroxy group, chloro, bromo, iodo,
aminooxalyloxy, an azido group, p-tolyloxythiocarbonyloxy,
or R25R26CHCOOxe2x80x94,
in which R25 is optionally protected hydroxy or protected amino, and
xe2x80x83R26 is hydrogen or methyl, or
R20 and R21 together form an oxygen atom in an epoxide ring; or
(c) cyclopentyl group substituted by methoxymethyl,
optionally protected hydroxymethyl, acyloxymethyl (in which the acyl moiety optionally contains either a dimethylamino group which may be quaternized, or a carboxy group which may be esterified), one or more amino and/or hydroxy groups which may be protected, or aminooxalyloxymethyl. A preferred example is a 2-formyl-cyclopentyl group.
The definitions used in the above general formula (I) and the specific and preferred examples thereof are now explained and set forth in detail.
The term xe2x80x9clowerxe2x80x9d means, unless otherwise indicated, a group having 1 to 6 carbon atoms.
Preferable examples of the xe2x80x9calkyl groupsxe2x80x9d and an alkyl moiety of the xe2x80x9calkoxy groupxe2x80x9d include a straight or branched chain aliphatic hydrocarbon residue, for example, a lower alkyl group such as methyl, ethyl, propyl, isopropyl, butyl, isobutyl, pentyl, neopentyl and hexyl.
Preferable examples of the xe2x80x9calkenyl groupsxe2x80x9d include a straight or branched chain aliphatic hydrocarbon residue having one double-bond, for example, a lower alkenyl group such as vinyl, propenyl (e.g., allyl group), butenyl, methylpropenyl, pentenyl and hexenyl.
Preferable examples of the xe2x80x9caryl groupsxe2x80x9d include phenyl, tolyl, xylyl, cumenyl, mesityl and naphthyl.
Preferable protective groups in the xe2x80x9cprotected hydroxy groupsxe2x80x9d and the xe2x80x9cprotected aminoxe2x80x9d are 1-(lower alkylthio)- (lower)alkyl group such as a lower alkylthiomethyl group (e.g., methylthiomethyl, ethylthiomethyl, propylthiomethyl, isopropylthiomethyl, butylthiomethyl, isobutylthiomethyl, hexylthiomethyl, etc.), more preferably C1-C4 alkylthiomethyl group, most preferably methylthiomethyl group;
trisubstituted silyl group such as a tri(lower)alkylsilyl (e.g., trimethylsilyl, triethylsilyl, tributylsilyl, tert-butyldimethylsilyl, tri-tert-butylsilyl, etc.) or lower alkyl-diarylsilyl (e.g., methyldiphenylsilyl, ethyldiphenylsilyl, propyldiphenylsilyl, tert-butyldiphenyl-silyl, etc.), more preferably tri(C1-C4)alkylsilyl group and C1-C4 alkyldiphenylsilyl group, most preferably tert-butyldimethylsilyl group and tert-butyldiphenylsilyl group; and an acyl group such as an aliphatic, aromatic acyl group or an aliphatic acyl group substituted by an aromatic group, which are derived from a carboxylic acid, sulfonic acid or carbamic acid.
Examples of the aliphatic acyl groups include a lower alkanoyl group optionally having one or more suitable substituents such as carboxy, e.g., formyl, acetyl, propionyl, butyryl, isobutyryl, valeryl, isovaleryl, pivaloyl, hexanoyl, carboxyacetyl, carboxypropionyl, carboxybutyryl, carboxyhexanoyl, etc.; a cyclo(lower)alkoxy(lower)alkanoyl group optionally having one or more suitable substituents such as lower alkyl, e.g., cyclopropyloxyacetyl, cyclobutyloxypropionyl, cycloheptyloxybutyryl, menthyloxyacetyl, menthyloxypropionyl, menthyloxybutyryl, menthyloxypentanoyl, menthyloxyhexanoyl, etc.; a camphorsulfonyl group; or a lower alkylcarbamoyl group having one or more suitable substituents such as carboxy or protected carboxy, for example, carboxy(lower)alkylcarbamoyl group (e.g., carboxymethylcarbamoyl, carboxyethylcarbamoyl, carboxypropylcarbamoyl, carboxybutylcarbamoyl, carboxypentylcarbamoyl, carboxyhexylcarbamoyl, etc.), tri-(lower)alkylsilyl(lower)alkoxycarbonyl(lower)alkylcarb amoyl group (e.g., trimethylsilylmethoxycarbonylethylcarbamoyl, trimethylsilylethoxycarbonylpropylcarbamoyl, triethylsilylethoxycarbonylpropylcarbamoyl, tert-butyldimethylsilylethoxycarbonylpropylcarbamoyl, tri-methylsilylpropoxycarbonylbutylcarbamoyl, etc.) and so on.
Examples of the aromatic acyl groups include an aroyl group optionally having one or more suitable substituents such as nitro, e.g., benzoyl, toluoyl, xyloyl, naphthoyl, nitrobenzoyl, dinitrobenzoyl, nitronaphthoyl, etc.; and an arenesulfonyl group optionally having one or more suitable substituents such as halogen, e.g., benzenesulfonyl, toluenesulfonyl, xylenesulfonyl, naphthalenesulfonyl, fluorobenzenesulfonyl, chlorobenzenesulfonyl, bromobenzenesulfonyl, iodobenzenesulfonyl, etc.
Examples of the aliphatic acyl groups substituted by an aromatic group include ar(lower)alkanoyl group optionally having one or more suitable substituents such as lower alkoxy or trihalo(lower)alkyl, e.g., phenylacetyl, phenylpropionyl, phenylbutyryl, 2-trifluoromethyl-2-methoxy-2-phenylacetyl, 2-ethyl-2-trifluoromethyl-2-phenylacetyl, 2-trifluoromethyl-2-propoxy-2-phenylacetyl, etc.
More preferable acyl groups among the aforesaid acyl groups are C1-C4 alkanoyl group optionally having carboxy, cyclo (C5-C6) alkoxy (C1-C4) alkanoyl group having two (C1-C4) alkyls at the cycloalkyl moiety, camphorsulfonyl group, carboxy-(C1-C4 ) alkylcarbamoyl group, tri(C1-C4)alkylsilyl(C1-C4)-alkoxycarbonyl (C1-C4)alkylcarbamoyl group, benzoyl group optionally having one or two nitro groups, benzenesulfonyl group having halogen, or phenyl(C1-C4)alkanoyl group having C1-C4 alkoxy and trihalo (C1-C4) alkyl group. Among these, the most preferable ones are acetyl, carboxypropionyl, menthyloxyacetyl, camphorsulfonyl, benzoyl, nitrobenzoyl, dinitrobenzoyl, iodobenzenesulfonyl and 2-trifluoromethyl-2-methoxy-2-phenylacetyl.
Preferable examples of the xe2x80x9c5- or 6-membered nitrogen, sulfur and/or oxygen containing heterocyclic ringxe2x80x9d include a pyrrolyl group and a tetrahydrofuryl group. xe2x80x9cA heteroaryl which may be substituted by suitable substituent (s) xe2x80x9d moiety of the xe2x80x9cheteroaryloxy which may be substituted by suitable substituent(s)xe2x80x9d may be the one exemplified for R1 of the compound of the formula of EP-A-532,088, with preference given to 1-hydroxyethyl-indol-5-yl, the disclosure of which is incorporated herein by reference.
The ticyclic compounds (I) and its pharmaceutically acceptable salt for use in accordance with this invention are well known to have excellent immunosuppressive activity, antimicrobial activity and other pharmacological activities and, as such, be of value for the treatment or prevention of rejection reactions by transplantation of organs or tissues, graft-vs-host diseases, autoimmune diseases, and infectious diseases [EP-A-0184162, EP-A-0323042, EP-A-423714, EP-A-427680, EP-A-465426, EP-A-480623, EP-A-532088, EP-A-532089, EP-A-569337, EP-A-626385, WO89/05303, WO93/05058, WO96/31514, WO91/13889, WO91/19495, WO93/5059, etc.], the disclosures of which are incorporated herein by reference.
Particularly, the compounds which are designated as FR900506 (=FK506), FR900520 (ascomycin), FR900523, and FR900525 are products produced by microorganisms of the genus Streptomyces, such as Streptomyces tsukubaensis No. 9993 [deposited with National Institute of Bioscience and Human Technology Agency of Industrial Science and Technology (formerly Fermentation Research Institute Agency of Industrial Science and Technology ), at 1-3, Higashi 1-chome, Tsukuba-shi, Ibaraki, Japan, date of deposit Oct. 5, 1984, accession number FERM BP-927] or Streptomyces hygroscopicus subsp. yakushimaensis No. 7238 [deposited with National Institute of Bioscience and Human Technology Agency of Industrial Science and Technology (formerly Fermentation Research Institute Agency of Industrial Science and Technology ), at 1-3, Higashi 1-chome, Tsukuba-shi, Ibaraki, Japan, date of deposit Jan. 12, 1985, accession number FERM BP-928][EP-A-0184162]. The FK506 (general name: tacrolimus) of the following chemical formula, in particular, is a representative compound. 
Chemical name: 17-allyl-1,14-dihydroxy-12-[2-(4-hydroxy-3-methoxycyclohexyl)-1-methylvinyl]-23,25-dimethoxy-13,19,21,27-tetramethyl-11,28-dioxa-4-azatricyclo[22.3.1.04,9] octacos-18-ene-2,3,10,16-tetraone
In the present invention, FK506 includes and may be in the form of its salt, isomer, or hydrate.
The preferred examples of the tricyclic compounds (I) are the ones, wherein each of adjacent pairs of R3 and R4 or R5 and R6 independently form another bond formed between the carbon atoms to which they are attached;
each of R8 and R23; is independently a hydrogen atom;
R9 is a hydroxy group;
R10 is a methyl group, an ethyl group, a propyl group or an allyl group;
X is (a hydrogen atom and a hydrogen atom) or an oxo group;
Y is an oxo group;
each of R14, R15, R16, R17, R18, R19, and R22 is a methyl group; R24 is a 3-R20-4-R21-cyclohexyl group,
in which R20 is hydroxy, an alkoxy group, or a xe2x80x94OCH2OCH2CH2OCH3 group, and
R21 is hydroxy, xe2x80x94OCN, an alkoxy group, a heteroaryloxy which may be substituted by suitable substituent(s) , a xe2x80x94CH,OCH,CH2OCH3 group, a protected hydroxy group, chloro, bromo, iodo, aminooxalyloxy, an azido group, p-tolyloxythiocarbonyloxy, or
R25R26CHCOOxe2x80x94,
in which R25is optionally protected hydroxy or protected amino, and
xe2x80x83R26 is hydrogen or methyl, or
R20 and R21 together form an oxygen atom in an epoxide ring; and
n is an integer of 1 or 2.
The most preferable tricyclic compounds(I) is, in addition to FK506, ascomycin derivatives such as halogenated-ascomycin (e.g., 33-epi-chloro-33-desoxyascomycin), which is disclosed in EP 427,680, example 66a. 
As the other preferable example of the macrolides as immunosuppressants, rapamycin [THE MERCK INDEX (12th edition) , No. 8288] and its derivatives can be exemplified. Preferred example of the derivatives is an O-substituted derivative in which the hydroxy in position 40 of formula A illustrated at page 1 of WO 95/16691, incorporated herein by reference, is replaced byxe2x80x94OR, in which R1 is hydroxyalkyl, hydroalkoxyalkyl, acylaminoalkyl and aminoalkyl; for example 40-O-(2-hydroxy)ethyl-rapamycin, 40-O-(3-hydroxy)propyl-rapamycin, 40-O-[2-2-hydroxy) ethoxy]ethyl-rapamycin and 40-O-(2-acetaminoethyl)-rapamycin. These O-substituted derivatives may be produced by reacting rapamycin (or dihydro or deoxo-rapamycin) with an organic radical attached to a leaving group (for example RX where R is the organic radical which is desired as the O-substituent, such as an alkyl, allyl, or benzyl moiety, and X is a leaving group such as CCl3C (NH) O or CF3SO3) under suitable reaction conditions. The conditions may be acidic or neutral conditions, for example in the presence of an acid like trifluoromethanesulfonic acid, camphorsulfonic acid, p-toluenesulfonic acid or their respective pyridinium or substituted pyridinium salts when X is CCl3C(NH)O or in the presence of a base like pyridine, a substituted pyridine, diisopropylethylamine or pentamethylpiperidine when X is CF3SO3. The most preferable one is 40-O-(2-hydroxy)ethyl rapamycin, which is disclosed in WO94/09010, the disclosure of which is incorporated herein by reference.
The tricyclic compounds(I), and rapamycin and its derivatives, have a similar basic structure, i.e., tricyclic macrolide structure, and at least one of the similar biological properties (for example, immunosupressive activity).
The tricyclic compounds(I), and rapamycin and its derivatives, may be in a form of its salt, which includes conventional non-toxic and pharmaceutically acceptable salt such as the salt with inorganic or organic bases, specifically, an alkali metal salt such as sodium salt and potassium salt, an alkali earth metal salt such as calcium salt and magnesium salt, an ammonium salt and an amine salt such as triethylamine salt and N-benzyl-N-methylamine salt.
With respect to the macrolide compounds, it is to be understood that there may be conformers and one or more stereoisomers such as optical and geometrical isomers due to asymmetric carbon atom(s) or double bond(s), and such conformers and isomers are also included within the scope of the present invention. And further, the macrolide compounds can be in the form of a solvate, which is included within the scope of the present invention. The solvate preferably include a hydrate and an ethanolate.
Further example of the immunosuppressant is cyclosporin and its derivatives such as cyclosporin A, B, C, D, E, F, G, etc, which are shown in THE MERCK INDEX (12th edition), No. 2821, U.S. Pat. Nos. 4,117,118, 4,215,199, 4,288,431, 4,388,307, Helv. Chim. Acta. 60, 1568(1977) and 65, 1655(1982), Transplant. Proc. 17, 1362(1985), and so on. Among which, the most preferable one is cyclosporin A. The disclosures of the above references are incorporated herein.
While the dosage of therapeutically effective amount of the immunosuppressants of the present invention varies from and also depends upon the age and condition of each individual patient to be treated, a daily dose of about 0.01-1000 mg, preferably 0.1-500 mg and more preferably 0.5-100 mg. of the active ingredient is generally given for treating diseases, and an average single dose of about 0.1 mg, 0.5 mg, 1 mg, 5 mg, 10 mg, 50 mg, 100 mg, 250 mg and 500 mg is generally administered.
In addition, this invention relates to enhancement of IGF-I production by an immunosuppressive macrolide compound. It is well known that IGF-I and its analogs have useful pharmacologic actions and are of value for the treatment of dwarfism, promotion of growth of mammary gland soft tissue, acceleration of bone growth, and treatment or prevention of renal diseases. Therefore, administration of a macrolide compound having IGF-I producing activity promotes the production of IGF-I and brings about benefits in the treatment or prevention of such IGF-I-responsive diseases.
The preferred macrolide compound includes the aforementioned tricyclo compound (I) and its pharmaceutically acceptable salt, with FK506 being particularly preferred.
In further aspects, this invention relates to a choleretic composition, bile acid secretion promoting composition or therapeutic composition for cholestasis, which comprises a compound having IGF-I producing activity, such as said macrolide compound, as an active ingredient, to a related method of therapy, and to a method of use thereof.
As mentioned above, IGF-I is not only useful for the therapy of dwarfism and promotion of bone growth but also has choleretic and bile acid secretion promoting actions. Therefore, it can be expected to be effective in the therapy of cholestasis as well. Therefore, by administering a compound having IGF-I producing activity to thereby induce IGF-I production in vivo, the beneficial effect ascribable to IGF-I can be attained without resort to the direct administration of IGF-I.
The xe2x80x9cIGF- I-producing compoundxe2x80x9d in the context of this invention means any compound that is capable of producing IGF-I but is preferably the macrolide compound mentioned hereinbefore, more preferably said tricyclo compound (I) and its pharmaceutically acceptable salt. Particularly preferred is FK506. The IGF-I -producing compound can be put to use in the form of neat compound or in the form of a composition prepared by formulating the compound with an optional pharmaceutical carrier, excipient, stabilizer and/or other pharmaceutically acceptable additives in the routine manner.
In this invention, such IGF-I -producing compound as an active ingredient can be used in the form of a solid, semisolid or liquid pharmaceutical preparation containing the same in admixture with an organic or inorganic carrier or excipient suitable for external application, intestinal administration, intramuscular administration or (other non-) oral administration. This active ingredient can be mixed with the conventional nontoxic pharmaceutically acceptable carrier for preparation of tablets, pellets, capsules, suppositories, solutions (e.g. in saline), emulsions, suspensions (e.g. in olive oil) and other dosage forms. The carrier which can be used includes solid, semisolid or liquid pharmaceutically acceptable carriers such as water, glucose, lactose, gum arabic, gelatin, mannitol, starch paste, magnesium trisilicate, talc, corn starch, keratin, colloidal silica, potato starch, urea and so on. In addition, various excipients, stabilizers, thickeners, coloring agents and flavors can also be added. The active ingredient is caused to occur in such a pharmaceutical composition at an effective concentration insuring the desired effect depending on the course or stage of disease. Such pharmaceutical compositions can be produced by the established technology.
For application of the IGF-I -producing compound according to this invention to human beings, it is preferably administered orally, parenterally, intestinally, or intramuscularly. Particularly when the IGF-I -producing compound is a macrolide compound, the therapeutically effective dose is judiciously selected according to the individual patient""s age, status of disease and other factors, and in terms of the daily dose of the compound may generally be about 0.01xcx9c1000 mg, preferably 0.1xcx9c500 mg, more preferably 0.5xcx9c100 mg. Usually, the average unit dose is about 0.1 mg, 0.5 mg, 1 mg, 5 mg, 10 mg, 50 mg, 100 mg, 250 mg or 500 mg.